Why Are Ventricular Repair (Cardiorrhaphy) Procedures Performed?

Ventricular repair (cardiorrhaphy) is a lifesaving procedure used for cardiac (heart) trauma.

Ventricular repair is also called cardiorrhaphy. It is a lifesaving procedure performed for cardiac (heart) trauma in the emergency room (ER). Emergency thoracotomy or surgical resuscitation may be done first prior to ventricular repair. 

Emergency thoracotomy is a procedure that allows immediate direct access to the chest to control bleeding and cardiac tamponade and treat injuries of the heart, lungs, or blood vessels in the chest. Emergency thoracotomy helps to assess the extent of injury and determine if cardiorrhaphy is required. 

Cardiac trauma is divided into the following two mechanisms:

• Blunt injury: The heart may rupture following a blunt force trauma to the chest. This type of a trauma leads to instant death before the patient can present to the ER.
• Penetrating injury: The heart can get injured due to a trauma from penetrating sharp objects. Although lethal, the patient can be saved with timely treatment. One of the most common causes of death from penetrating trauma wounds is cardiac tamponade. Cardiac tamponade is a condition in which fluid fills up within the pericardium (the sac around the heart), leading to compression of the heart. Exsanguination is a severe loss of blood that can lead to death.

The ventricles in the heart are involved in 80% of penetrating cardiac injuries.

A penetrating trauma to the chest in an unstable patient is an indication for emergency thoracotomy and possible cardiorrhaphy.

The indications for emergency thoracotomy with or without cardiorrhaphy include the following:

• Cardiac arrest (heart attack) in patients with penetrating chest injuries
• Persistent hypotension (decreased blood pressure) or signs of cardiac tamponade
• Cardiac arrest in the emergency room (ER) following a blunt trauma

Contraindications for ventricular repair include the following:

• Clinically stable patients
• Blunt trauma with no vital signs
• Unsalvageable patients (decapacitated patients)
• Patient is deceased by the time they reach the hospital

The surgery involves the patient being put under anesthesia. There are two different types of procedures in which a ventricular repair is performed.

• Thoracotomy procedure: A deep incision is made usually between the fourth or fifth intercostal space (the space between two ribs), which is below the nipple just to the left of the breastbone.
• Cardiorrhaphy procedure: The chest cavity is exposed. The major blood vessels and nerves supplying blood to the heart are identified and isolated. The wound in the heart is identified. Depending on the size, a finger or a catheter may be used to plug the wound until the surgeon prepares the suture material. The wound may be sutured or stapled in layers.

Potential complications of ventricular repair include the following:

• Injury to underlying structures in the chest such as the lungs, heart, blood vessels, nerves and esophagus (food pipe)
• Uncontrolled bleeding 
• Postpericardiotomy syndrome (characterized by fever, chest pain, pericardial effusion, and electrocardiogram [ECG] changes)
• Arrhythmias (irregular heart rhythm)
• Postoperative infection
• Increased risk to physicians, nurses, and other staff of exposure to infectious blood and tissue such as HIV, Hepatitis B, etc., because it is an emergency procedure.